Wang Peng,Huang Soujiang,Lyu Chenjie,et al.Robotic-assisted surgery in neonates with congenital intestinal malrotation[J].Journal of Clinical Pediatric Surgery,,22():876-880.[doi:10.3760/cma.j.cn101785-202203003-015]
Robotic-assisted surgery in neonates with congenital intestinal malrotation
- Keywords:
- Robotic Surgical Procedures; Duodenal Obstruction; Surgical Procedures; Operative; Infant; Newborn
- Abstract:
- Objective To summarize the outcomes of robotic-assisted surgical system for congenital intestinal malrotation (CIM).Methods From August 2020 to June 2021,15 CIM neonates underwent robotic-assisted surgery.The relevant clinical data、Surgery-related data,postoperative recovery were collected retrospectively.By analyzing the preoperative,intraoperative and prognosis of the children,The robotic-assisted surgical system for congenital intestinal malrotation was summarized.Results Of the 15 children,13 were male and 2 female; gestational age 36+2 to 40+4 weeks; 2 premature infants,13 term infants; 7 caesarean section,8 vaginal delivery; operation age (11.7±5.9) d; weight (3 065±377) g; Preoperative ultrasound test showed that 7 cases with volvulus 720,5 cases with volvulus 540,3 cases with volvulus 360; 12 cases with biliary vomiting,3 cases with non-biliary vomiting; 4 cases with combined atrial septal defect,2 cases with complicated patent artery duct,2 cases with combined ventricular septal defect and the remaining 7 cases without cardiac malformation。All of them underwent robotic-assisted procedures without any conversion into open surgery.The average operative duration was (57±8) min,the average system installation time (14±3) min,the average intra-abdominal pressure (IAP)(5.6±0.3)mmHg and the average end-tidal carbon dioxide (38.4±4.3) mmHg.The intra-operative bleeding volume was from 1 to 3 ml,the average mechanical ventilation time (5.2±1.8) hours,the average Initial oral feeding time (3.1±1.2) days,the average sufficient feeding time (7.2±1.8) days and the average hospitalization time (12.1±2.7) days.One child was re-operated due to an obstruction of focal intestinal adhesion.Another case was hospitalized for 27 days and it was significantly longer than other children due to abnormal intestinal motility.The remainders recovered well with no postoperative complications such as vomiting,abdominal distension or incision infection.During postoperative follow-ups,all of them were well fed with satisfactory surgical incision healing and normal growth and development.Conclusion Robot-assisted surgery is both safe and feasible for neonatal CIM and offers excellent outcomes.
References:
[1] Kumar P,Kumar C,Pandey PR,et al.Congenital duodenal obstruction in neonates:over 13 years’ experience from a single centre[J].J Neonatal Surg,2016,5(4):50.DOI:10.21699/jns.v5i4.461.
[2] 李索林,温哲,时保军,等.小儿腹腔镜下先天性十二指肠梗阻的诊治[J].中华小儿外科杂志,2005,26(4):183-185.DOI:10.3760/cma.j.issn.0253-3006.2005.04.005. Li SL,Wen Z,Shi BJ,et al.Laparoscopic diagnosis and treatment of congenital duodenal obstruction in children[J].Chin J Pediatr Surg,2005,26(4):183-185.DOI:10.3760/cma.j.issn.0253-3006.2005.04.005.
[3] 张书豪,高志刚,钭金法,等.机器人手术在小儿外科领域的应用现状[J].临床小儿外科杂志,2021,20(8):701-707.DOI:10.12260/lcxewkzz.2021.08.001. Zhang SH,Gao ZG,Tou JF,et al.Current applications of robotic procedures during pediatric surgery[J].J Clin Ped Sur,2021,20(8):701-707.DOI:10.12260/lcxewkzz.2021.08.001.
[4] 汤绍涛.机器人手术在小儿外科中的发展现状及展望[J].机器人外科学杂志(中英文),2021,2(4):241-247.DOI:10.12180/j.issn.2096-7721.2021.04.001. Tang ST.Current status and future prospects of robot-assisted surgery in children:[J].Chin J Robot Surg,2021,2(4):241-247.DOI:10.12180/j.issn.2096-7721.2021.04.001.
[5] 黄格元,蓝传亮,刘雪来,等.达芬奇机器人在小儿外科手术中的应用(附20例报告)[J].中国微创外科杂志,2013,13(1):4-8.DOI:10.3969/j.issn.1009-6604.2013.01.002. Huang GY,Lan CL,Liu XL,et al.Da Vinci robotic system for pediatric surgery:a report of 20 cases[J].Chin J Minim Inva Surg,2013,13(1):4-8.DOI:10.3969/j.issn.1009-6604.2013.01.002.
[6] 胡书奇,吕成杰,韩一江,等.腹腔镜技术在不同出生体重新生儿十二指肠梗阻中的应用研究[J].临床小儿外科杂志,2020,19(9):800-805.DOI:10.3969/j.issn.1671-6353.2020.09.008. Hu SQ,Lyu CJ,Han YJ,et al.Application of laparoscopic technique for duodenal obstruction in neonates with different birth weights[J].J Clin Ped Sur,2020,19(9):800-805.DOI:10.3969/j.issn.1671-6353.2020.09.008.
[7] 陈兰萍,任红霞,陈淑芸,等.腹腔镜诊治小婴儿肠旋转不良的探讨[J].临床小儿外科杂志,2004,3(6):409-411.DOI:10.3969/j.issn.1671-6353.2004.06.003. Chen LP,Ren HX,Chen SY,et al.Diagnosis and therapy of congenital intestinal malrotation by laparoscopy in neonates and toddlers[J].J Clin Ped Sur,2004,3(6):409-411.DOI:10.3969/j.issn.1671-6353.2004.06.003.
[8] 阳历,张茜,汤绍涛.手术机器人在小儿外科领域应用的机遇与挑战[J].中华小儿外科杂志,2015,36(10):791-794.DOI:10.3760/cma.j.issn.0253-3006.2015.10.019. Yang L,Zhang Q,Tang ST.Opportunities and challenges of surgical robot application in the field of pediatric surgery[J].Chin J Pediatr Surg,2015,36(10):791-794.DOI:10.3760/cma.j.issn.0253-3006.2015.10.019.
[9] 李芹,刘文英.人工智能在小儿外科领域的应用及展望[J].中华小儿外科杂志,2021,42(1):76-81.DOI:10.3760/cma.j.cn421158-20190813-00496. Li Q,Liu WY.Applications and future prospects of artificial intelligence in pediatric surgery[J].Chin J Pediatr Surg,2021,42(1):76-81.DOI:10.3760/cma.j.cn421158-20190813-00496.
[10] 周辉霞,曹华林.机器人辅助腹腔镜手术在小儿泌尿外科的应用与现状[J].中华腔镜外科杂志(电子版),2018,11(2):72-76.DOI:10.3877/cma.j.issn.1674-6899.2018.02.003. Zhou HX,Cao HL.Application and current status of robot-assisted laparoscopy during pediatric urology[J].Chin J Laparosc Surg (Electron Ed),2018,11(2):72-76.DOI:10.3877/cma.j.issn.1674-6899.2018.02.003.
[11] Avery DI,Herbst KW,Lendvay TS,et al.Robot-assisted laparoscopic pyeloplasty:multi-institutional experience in infants[J].J Pediatr Urol,2015,11(3):139.e1-139.e5.DOI:10.1016/j.jpurol.2014.11.025.
[12] 冯翠竹,李龙,马继东,等.经脐单部位腹腔镜治疗新生儿十二指肠梗阻[J].中国微创外科杂志,2019,19(1):50-52.DOI:10.3969/j.issn.1009-6604.2019.01.014. Feng CZ,Li L,Ma JD,et al.Transumbilical single-site laparoscopy for neonatal duodenal obstruction[J].Chin J Minim Inva Surg,2019,19(1):50-52.DOI:10.3969/j.issn.1009-6604.2019.01.014.
[13] Catania VD,Lauriti G,Pierro A,et al.Open versus laparoscopic approach for intestinal malrotation in infants and children:a systematic review and meta-analysis[J].Pediatr Surg Int,2016,32(12):1157-1164.DOI:10.1007/s00383-016-3974-2.
[14] Son TN,Kien HH.Laparoscopic versus open surgery in management of congenital duodenal obstruction in neonates:a single-center experience with 112 cases[J].J Pediatr Surg,2017,52(12):1949-1951.DOI:10.1016/j.jpedsurg.2017.08.064.
[15] 张茜,汤绍涛,曹国庆,等.da Vinci机器人辅助腹腔镜Soave拖出术治疗先天性巨结肠症[J].中国微创外科杂志,2016,16(2):165-167,184.DOI:10.3969/j.issn.1009-6604.2016.02.019. Zhang Q,Tang ST,Cao GQ,et al.Robotic-assisted Da Vinci robot-assisted Soave pull-through for Hirschsprung’s disease in infants[J].Chin J Minim Inva Surg,2016,16(2):165-167,184.DOI:10.3969/j.issn.1009-6604.2016.02.019.
Memo
收稿日期:2022-3-1。
基金项目:浙江省基础公益研究计划项目(LY22H040006)
通讯作者:钭金法,Email:toujinfa@zju.edu.cn